Whiplash-Associated Disorders

EVIDENCE-BASED MEDICINE
Evidence-based Interventional Pain Medicine according to Clinical Diagnoses
7. Whiplash-Associated Disorders 
Hans van Suijlekom, MD, PhD*; Nagy Mekhail, MD, PhD, FIPP † ; Nileshkumar Patel, MD, MBA ‡ ; Jan Van Zundert, MD, PhD, FIPP § ; Maarten van Kleef, MD, PhD, FIPP ¶ ; Jacob Patijn, MD, PhD ¶
*Department of Anesthesiology and Pain Management, Catharina Ziekenhuis, Eindhoven, The Netherlands; ¶ Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; † Pain Management Department, Anesthesiology Institute, Cleveland, Ohio, USA; ‡ Pain and Rehabilitation, Coastal Orthopedics, Cleveland Clinic, Bradenton, Florida, U.S.A.; § Department of Anesthesiology and Multidisciplinary Pain Centre, Ziekenhuis Oost-Limburg, Genk, Belgium
Correspondence to Maarten van Kleef, MD, PhD, Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: maarten.van.kleef@mumc.nl 

ABSTRACT

Whiplash-associated disorders are comprised of a range of symptoms of which neck complaints and headaches are the most significant spine related.

In the acute and sub-acute stage of the disorder, conservative treatment for minimally 6 months is recommended, active mobilization is slightly better than passive treatment. Thereafter, interventional treatment may be considered. The available evidence for injection of Botulinum toxin A (2 B−) and intra-articular corticosteroid injections (2 C−) supports a negative recommendation.

Radiofrequency treatment of the ramus medialis (medial branch) of the ramus dorsalis is recommended (2 B+).